Background: Culture-negative endocarditis caused by Bartonella henselae is often difficult to diagnose. We report a patient in whom molecular testing on whole blood permitted rapid pathogen identification and subsequent medical management of B. henselae aortic PVE and graft infection.
A 58-year old man with Ehlers-Danlos syndrome presented with 7 weeks of fevers, drenching night sweats and an 8-pound weight loss. His past medical history was notable for an aortic graft, mechanical aortic valve and a mitral anulloplasty ring placed 10 years before presentation. He lived with a monkey and 15 cats on an organic farm where he walked barefoot while plowing soil. He previously kept goats. Blood cultures obtained before starting antibiotics were negative for pathogens. A trans-esophogeal echocardiogram did not reveal any valvular lesions or vegetations. Figure 1 shows an 18fluorodeoxyglucose-positron emission tomography/computed tomography (18FDG-PET/CT) scan that detected abnormal hypermetabolic activity in the aortic arch (A), aortic root/valve prosthesis (B), spleen (C) and axillary region of the right subclavian artery (D).
Methods: Nucleic acid testing using research based PCR/electrospray ionization mass spectrometry (PCR/ESI-MS) and sequencing targeting 16S rRNA genes was performed on whole blood. Western blots (WB) tested serum for antibodies against Bartonella spp.
detected Bartonella henselae from
blood samples collected on hospital days 2 and 3. WB yielded a
reactivity pattern consistent with Bartonella henselae infection. The patient received 4 weeks of
gentamicin concurrent with 8 weeks of ceftriaxone. His symptoms improved within 6 days
of starting antibiotics. He remains
asymptomatic while on daily doxycycline for suppression.
D. Raoult, None
R. Sampath, Ibis Biosciences, Abbott: Employee , Salary
R. A. Bonomo, Merck: Grant Investigator , Grant recipient
Allergan: Grant Investigator , Grant recipient
Wockhardt: Grant Investigator , Grant recipient
R. Jump, Pfizer: Grant Investigator , Grant recipient